Long-term (≥15 years) Follow-up of Percutaneous Coronary Intervention of Unprotected Left Main (From the GRAVITY...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• Percutaneous Coronary Intervention (PCI) for Unprotected Left Main Coronary Artery (ULMCA) is a complex procedure.
• Long-term survival data and predictors of mortality after ULMCA PCI are crucial for patient management and risk stratification.

Purpose of the Study:

• To evaluate long-term survival and identify determinants of mortality after PCI on ULMCA.
• To assess the impact of repeated PCI on ULMCA on long-term outcomes.

Main Methods:

• Retrospective analysis of 470 consecutive patients undergoing PCI on ULMCA between 2002 and 2005 across 9 European centers.
• Primary endpoints were all-cause and cardiovascular (CV) death; secondary endpoints were predictors of mortality identified via multivariate analysis.
• Follow-up extended to 15 years, with assessment of repeated PCI procedures.

Main Results:

• After a median of 15 years, 47% of patients died from all causes, and 17.2% died from CV causes.
• Multivariable analysis identified older age, left ventricular ejection fraction (LVEF) < 35%, and the number of vessels treated during index PCI as predictors of all-cause mortality.
• Only LVEF < 35% was a significant predictor of CV death. Repeated PCI on ULMCA did not significantly impact survival.

Conclusions:

• PCI on ULMCA in a large, unselected population is associated with significant long-term mortality.
• Older age, reduced LVEF, and treatment of multiple vessels during the initial PCI are associated with increased all-cause mortality.
• Repeated PCI procedures on ULMCA do not appear to influence long-term survival outcomes.